Hernias

Question 1

Strangulated definition

Answer 1

Blood supply compromised due to pressure at neck of hernia

Question 2

Maydl’s Hernia

Answer 2

Herniating double loop of bowel. Strangulated portion may reside as a single loop inside the abdomen

Question 3

Littre’s hernia

Answer 3

Hernial sac containing strangulated Meckel’s diverticulum (small pouch in small intestine near umbilicus)

Question 4

Amyand’s hernia

Answer 4

Inguinal hernia containing strangulated Appendix

Question 5

Richter’s hernia

Answer 5

Only part of circumference of bowel is within sac Most commonly seen with femoral hernias.
Can strangulate without obstructing.

Question 6

Pantaloon

Answer 6

Simultaneous direct (being fat/old) and indirect(congenital abnormality) hernia

Question 7

Herniotomy

Answer 7

Excision of hernial sac

Question 8

Herniorrhaphy

Answer 8

Suture repair of hernial defect

Question 9

Hernioplasty

Answer 9

Mesh repair of hernial defect

Question 10

Epidemiology of inguinal hernias

Answer 10

M>F 9:1 due to descent of testes

Commoner on the right

Question 11

Indirect inguinal hernias

Answer 11

• 80%: commoner in young
• Congenital patent processus vaginalis
• Emerge through deep ring
• Same 3 coverings as cord and descend into the scrotum
• Can strangulate

Question 12

Direct inguinal hernias

Answer 12

• 20%: commoner in elderly
• Acquired (increased intra-abdominal pressure)
• Emerge through Hesselbach’s triangle
• Can acquire internal and external spermatic fascia
• Rarely descend into scrotum
• Rarely strangulate

Question 13

Questions to ask for inguinal hernias

Answer 13

• Reducible?
• Ever episodes of obstruction / strangulation?
• Predisposing factors: cough, straining, lifting?
• Occupation and social circumstances?
• Children worse when crying?

Question 14

Treatment of inguinal hernias

Answer 14

Non-surgical
- Reduce Risk Factors: cough, constipation
- Lose weight
- Truss (hernia pants)
Surgical
- Tension-free mesh

Question 15

Femoral hernia definition

Answer 15

Protrusion of viscus through femoral canal

Question 16

Clinical features of femoral hernias

Answer 16

Painless groin lump:
- neck inferior/lateral to pubic tubercle
- cough impulse
- often irreducible
Often present with strangulation/obstruction:
- Tender, red, hot
- Abdo pain, distension, vomiting, constipation

Question 17

Treatment of femoral hernias

Answer 17

50% risk of strangulation within 1 month so urgent surgery needed:
Elective = Lockwood approach
Emergency = McEvedy approach

Question 18

Incisional Hernias definition

Answer 18

Hernia through surgical incision

Question 19

Risk factors for incisional hernias (pre/intra/post operation)

Answer 19

Pre op:
- Age
- Obesity
Intra-op:
- Surgical skill (inappropriate sutures)
- Incision type
- Placing drains through wounds
Post-op:
- Increased intra abdo pressure
- Infection 
- Haematoma

Question 20

Treatment of incisional hernias

Answer 20

Conservative
- Manage risk factors: e.g. constipation, cough
- Weight loss
- Elasticated corset or truss
Surgical
- Nylon mesh repair: open or lap

Question 21

Risk factors of umbilical hernias

Answer 21

• Afro-Caribbean
• Trisomy 21 (Down’s)
• Congenital hypothyroidism

Question 22

Management of umbilical hernias

Answer 22

• Usually resolves by 2-3yrs
• Mesh repair if no closure.
• Can recur in adults: pregnancy or gross ascites

Question 23

Paraumbilical hernia features

Answer 23

• Acquired: middle aged obese men
• Defect through linea alba just above or below
  umbilicus
• Small defect –> strangulation (often omentum)

Question 24

Parumbilical hernia treatment

Answer 24

Mayo technique (sutures) or Mesh repair

Question 25

Epigastric hernia features

Answer 25

- Young, M>F - Pea-sized swelling caused by defect in linea alba above the umbilicus. - Usually contains omentum: can strangulate

Question 26

Treatment of epigastric hernias

Answer 26

Mesh repair